Definition

Symptoms

Most patients with autoimmune hepatitis have no symptoms. The disorder is often first detected by abnormal liver function tests found on blood testing (such as for a life insurance examination).

For the more severe disease, the most common symptom is fatigue. Some people also have symptoms of hepatitis such as fever and jaundice (yellowing of the skin or eyes or dark urine). Other symptoms include itching, skin rashes, joint pain, abdominal discomfort, abnormal blood vessels in the skin, nausea and vomiting and loss of appetite.

In its most advanced form, autoimmune hepatitis can progress to cirrhosis (scarring of the liver).

Who is at risk

It is not clear why autoimmune hepatitis develops. Researchers suspect that some people inherit a genetic disposition that could make them more likely to develop it.

Sometimes drugs or infections trigger the development of the disease. Patients with autoimmune hepatitis may also have other autoimmune disorders, such as thyroiditis (inflammation of the thyroid), ulcerative colitis (inflammation of the bowel), diabetes mellitus, vitiligo (patches of skin discolouration), lupus or Sjögren's syndrome (inflammation of the salivary and tear glands).

• Type 1 autoimmune hepatitis can affect people of any age or gender• Type 2 autoimmune hepatitis primarily affects girls and young women, and is less common

When to seek medical advice

Treatment (provided by NUH)

• Autoimmune hepatitis is diagnosed with blood tests and a liver biopsy. During a liver biopsy, a small sample of liver tissue is removed with a needle and examined under a microscope.

• Autoimmune hepatitis is usually treated first with a glucocorticoid (such as prednisone). Prednisolone at a high dosage, during long-term treatment, can lead to weight gain, bone loss, elevated blood glucose levels (potentially leading to diabetes), an increased risk of infections, cataracts, high blood pressure, mood and sleep disturbance.

Duration of Treatment

As a general rule, treatment should continue until the disease is in remission.

Remission is defined as a lack of symptoms, normal levels of liver blood tests or absence of liver inflammation.

Approximately 65 and 80 percent of patients achieve remission within 18 months and three years respectively. About 50 percent of patients remain in remission or have only mild disease activity for months to years after treatment is stopped. However, patients whose disease relapses or becomes active again may have to restart treatment.

A relapse typically occurs within the first 15 to 20 months after treatment is stopped and is more likely in those who have cirrhosis on the initial liver biopsy.